I was posed a simple question - If I had infinite resources, infinite time, and no legacy compatibility issues, how would I design the electronic health record of the future?

The web is the way. Given the 24x7 nature of healthcare, the need for physicians to be in many physical locations, and the multitude of clinician computing devices, the ideal EHR should be web-based, browser neutral and run flawlessly on every operating system. I highly recommend the use of AJAX techniques to give physicians a more real time interactive experience. Client/Server may have some user interface advantages, but it's just too challenging to install thick clients on every clinician computing device. Citrix is an expensive and sometimes slow remote access solution. Native web works.

For the non-geek part of the blog, I reference a post simply called "Go Climb A Rock:"

It's Thursday, so it's time for a personal introspection blog. At times I get quizzical looks for being vegan, playing the Japanese flute, or wearing black. However, the most unusual looks from my peers occur when they see photos like this one of Dark Shadows on Mescalito North in Red Rocks, Nevada.

Winter mountaineering is a good way to get away from your cell phone (the battery life is 2 minutes at -40F), but why climb a rock? Think of climbing a mountain as a giant Rubik's cube - a wonderful mental exercise. Climbing requires a well orchestrated combination of gear, route finding, movement, and teamwork to make it to the top.

So, needless to say, this is interesting stuff. So, tune in Thursday, May 1st at 9pm Eastern Time where we will be talking about his blog and a whole lot more. You can also join us in the live chat room or even call into the show to ask us a question. Check back here tomorrow for details!

Tuesday, April 29, 2008

You may remember this story from last month. An 11 year-old girl died following the complications of untreated diabetic ketoacidosis (DKA). Now, DKA is a serious condition and strikes fear in anyone who has diabetes. However, if recognized early, this is a treatable. And, for the most part, DKA has a good recovery rate.

The parents of this child did not see it necessary to seek medical attention for their daughter. Instead, they felt that faith alone along with prayer would be enough to heal their daughter. This Associated Press story continues:

Madeline Neumann died March 23 -- Easter Sunday -- at her family's rural Weston home. Her parents were told the body would be taken to Madison for an autopsy the next day. "They responded, 'You won't need to do that. She will be alive by then,"' the medical examiner wrote in a report.

Family and friends had urged Dale and Leilani Neumann to get help for their daughter, but the father considered the illness "a test of faith" and the mother never considered taking the girl to the doctor because she thought her daughter was under a "spiritual attack," the criminal complaint said.

The story states that each parent may face as many as 25 years in prison. What's unfortunate is that I don't think that these people really care about that. They probably still feel (and will always feel) that they did the right thing in not seeking medical attention. I do not see any remorse in these parent's future.

Now, I consider myself a spiritual-type person. But, as I read story after story after story of what people do in the name of some higher power somewhere - it really frightens me. For the most part, I still believe that there is more good in this world. But, even my faith gets tested sometimes. And, this story is one of those times....

Monday, April 28, 2008

Here is a simple, yet, controversial question: If someone has used marijuana - even if used for medical reasons - should this prohibit him or her from being considered to be on a transplant list? Hospitals throughout this great nation struggle with this question every day.

Timothy Garon (pictured above) is a patient at the University of Washington Medical Center. He has end stage Hepatitis C and, according to this Associated Press story, may be in his final days without a liver transplant.

But Garon's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons. "I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs. And with cases like Garon's, they also have to consider — as a dozen states now have medical marijuana laws — if using dope with a doctor's blessing should be held against a dying patient in need of a transplant.

Now, according to the American Liver Foundation, in 2005, approximately 6500 liver transplants were performed in the United States. Also, according to the site, it states that about 17000 Americans are on the liver transplant list. Interestingly enough, the CDC website states that the number of new infections with Hepatitis C has decreased from 240000 in the 1980s to about 19000 in 2006.

The issue of who should and who should not receive a transplant is always controversial. I think the issue of use of marijuana is interesting as I have blogged about it before here,here, and here.

Even though this gentleman's story is very compelling, I'm going to have to side with the hospital on this one. I agree with what was said by Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina. "Marijuana, unlike alcohol, has no direct effect on the liver. It is however a concern ... in that it's a potential indicator of an addictive personality." (And in my book, not a good candidate for a transplant.)

Friday, April 25, 2008

Thanks so much to my guests Kevin MD and Dr. Val for coming on the show. (See video post above) Not only did Kevin talk about his recent USA Today Op-Ed piece, but also why physicians should write opinion pieces for blogs, for newspapers, and other media sources.

I was only able to schedule 60 minutes live time and we went another 30 minutes over. In this last 30 minutes, we talked about personal health information out there on the internet. Great conversation and springboard for our guest next week who is John Halamka from GeekDoctor.

Thanks also to my callers MexicoMedStudent and Dr. Rob. I appreciate you contributing to the conversation. Thanks to those who were able to join us in the live chat room. And, thanks to all of you for listening to the show either live and/or on the archives. I really appreciate everyone's continued support of the show. Have a great weekend! (Don't forget to rate the show right here!)

I'm very happy to announce that Kevin MD will be back on the show to talk about his 4/23/08 USA Today Op-Ed piece entitled "Wasted Medical Dollars" talking about the reality of the practice of defensive medicine. As of this posting, there are already about 30 total comments on Kevin's site and on the USA Today site. Interesting discussion.

Normally, that would be enough for one show. But, wait, there's more! Dr. Val will also be joining the show at some point to discuss a bunch of things. First, Revolution Health is celebrating their one year anniversary and she was part of the festivities on that. Second, last week, she interviewed the former US surgeon general and that interview will be going up on her site soon. Finally, she hosted Grand Rounds this week. Sheesh! I'm tired just reading this. So, hopefully, she'll be updating us on how here week has been going.

You can even take part in the chat room. It is truly "The show within the show." You can even call in and say hello. A great opportunity to interact with medbloggers you've only read about. See you later!

For first time Blog Talk Radio listeners:*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Wednesday, April 23, 2008

The scene above is from Seinfeld. The episode is called "The Contest." The phrases "master of my domain" and "king of the castle" are in this episode. Check it out above to see the beginning of the episode. What does this have to do with preventing prostate cancer? Well, I'll let the story below explain itself:

Men who frequently masturbate appear to have a lower risk of developing prostate cancer, Australian researchers reported. Researchers from the Cancer Council of Victoria found that men who masturbated more than five times each week were one-third less likely to develop the cancer.

Researchers told the BBC last week that the prostate produces one of the fluids involved in ejaculation and that frequent masturbation appears to flush out carcinogens. Sexual intercourse may not have the same effect because it increases the risk of contracting a sexually transmitted disease, which could raise the risk of cancer.

Uh, yeah. Can you see me giving this advice to my patients? However, I can see some people bringing me this story this very afternoon and asking me about it. Usually for research studies, I say that I need to see more studies done. But, in this case, I think I'll pass on that. What do you think?

Update: This afternoon, US News & World Report is now questioning this entire study and story - even questioning the FoxNews.com quote from above. It really doesn't matter to me. It's kind of a funny story. But, I guess it shows that even the masturbation deniers are out there! hehe

A recent analysis by PricewaterhouseCoopers concluded that more than half of the dollars in our $2.2 trillion health care system are wasted.

Medical errors, inefficient use of information technology, and poorly managed chronic diseases were all cited as factors. Dwarfing these reasons is a phenomenon in which doctors order tests to avoid the threat of a malpractice lawsuit. This is known as 'defensive medicine.'

At $210 billion annually, defensive medicine is one of the largest contributors to wasteful spending, and it can manifest in many forms: unnecessary CT scans, MRIs, cardiac testing and hospital admissions. A 2005 survey in the Journal of the American Medical Association found that 93% of doctors reported practicing defensive medicine.

Kudos to Kevin for not only bringing more light on this subject, but also bringing more light onto the medical blogosphere through his writing and opinions. Spread the word about his op-ed today. Blog about it. This topic is very important, and Kevin has done so much for our blogging community. Keep it up, Kevin MD!

Tuesday, April 22, 2008

There have been many in the medical blogosphere who have (correctly) predicted the soon-to-be disaster of a shortage of primary care physicians. I, of course, agree with my primary care and family physician brethren on this point.

Well, now, there is new data from the University of Washington stating that General Surgery as a specialty is soon going to be in a world of hurt because - frankly, there are no medical students going into it. Obviously, this is part of the super-specialty revolution where generalists - whether they be general medicine physicians or general surgery physicians - are going to be more rare.

I find it ironically funny (in some strange way) that the quote below used to describe the shortage for general surgeons is vaguely familiar and kind of deja vu like when I remember why medical students are not choosing primary care:

Young doctors put a higher value on their personal lives, making fields that require frequent and unpredictable hospital duties less attractive, said Dr. Dana Lynge, a general surgeon and lead author of the study from the UW. In addition, he said, many students leave medical training with a "mountain of debt" in school loans. By necessity, they are looking for careers that will help them get out of the hole. The combination of less-demanding fields and more lucrative payoffs draws students away from general surgery.

We're definitely feeling this in our small little community in Northeastern Ohio. When there is a demand like this, students who actually choose general surgery can go wherever they want. Why would they want to come to NE Ohio? So, recruiting new docs (in all specialties) has been difficult and will be difficult.

So, to the leaders of the general surgery specialty, all I can say is "I feel your pain" and "Welcome to my world." If you figure out a way to somehow increase the supply of general surgeons, let me know, because I'll "steal" your techniques to try to increase the primary care physician workforce. Because without primary care PHYSICIANS (not just primary care "providers"), general surgeons (and other specialties) will have no referral base. How 'bout them apples!

Grand Rounds 4.31 is now up and running over at Dr. Val and the Voice of Reason. She has grouped the post by feeling, which I don't think has ever been done before. And, she added a little cute tagging system to point out the especially good posts of the week.

I admit that I have been a slug and not writing as much and contributing to Grand Rounds. I feel badly about that. But, I'm feeling a little resurgence, so maybe the posts will start flying again. Thanks to Dr. Val for including my post this week:

Dr. A from Doctor Anonymous wonders if peace and contentment come from accepting one's lot in life. His post is called, "With Age Comes Happiness?"

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, Grand Rounds moves to the site called Doc Gurley.

Monday, April 21, 2008

Now, you're going to think that I'm totally making this story up and that it's untrue. Well, it's from MSNBC, so you can make your own conclusions there. Anyway, here's the first sentence from the story, "Pee from more than 4,000 volunteers shows that people from different nations often have spectacularly different metabolisms."

And, off we go! Ok, so, I'm trying to visualize the newspaper ad that had to go out on this one: "Seeking pee from people worldwide for research study." And, they got 4,000 people to participate? Fascinating. What did they find? Well, different people from different nations had different metabolites in their urine (no kidding).

"For instance, Chinese and Japanese people are almost identical genetically, which isn't surprising, since they diverged culturally only a few thousand years ago — but they are very different metabolically," said researcher Jeremy Nicholson, a biological chemist at Imperial College London.

"We know there's a huge difference in the diseases that different nations risk — broadly speaking, the Japanese tend to die of strokes, the Chinese of heart attacks — and we see those differences reflected in their urine," he added. "Of course they're different in terms of lifestyle — the Japanese tend to eat more fish than the Chinese as a whole do — but their gut bacteria are also very distinct as well."

Now, why is this important? According to the article, the substances found may help shed light on things like diabetes, vascular diseases, obesity, and even cancer. Sure, that's great. But, I'd hate to be the poor freshman college student asked to do all the grassroots work on this paper. Is getting a published research paper worth it to work with all this urine? I guess so. Wonder what the follow-up research will hold?

So, one of my patients today asked me about a surgical cure for diabetes. The only things I ever heard about were experimental procedures with the islet cells of the pancreas or something along those lines. But, then, the patient said something about gastric bypass surgery. I was mildly intrigued.

This person said that they they saw a report on 60 minutes. "Oh great," I thought to myself. So, I checked out the website over there and there is not one but about four videos over there talking about this. You're going to love this. The titles of the reports are the following: The ABCs of gastric bypass surgery; Diabetes cure?; Immediate relief; and Here's the hitch.

So, if for anything else, to get me up to speed with what my patients are watching, these reports claim a "cure" for diabetes - meaning to them that their patients leave the hospital following their surgery without any diabetes meds. And, one of the final reports says that it's a shame that more people (meaning non-obese people) do not qualify for this surgery. No wonder a lot of people asked me about this surgery today at the office.

Now, I know that I may get beat up by some people out there, but this situation is so much a reflection of our society today. People are looking for the quick fix and then everything will be better. "All I need is this surgery and then I can start living my life again," people think to themselves.

It's so interesting how people think. I can't give away flu shots or pneumonia vaccines because "they cause the flu" or "I get a rash from it." For gastric bypass surgery, just reading from the webmd website, has risks for blood clots and infection. And, something called "dumping syndrome" which goes something like this.

Another risk of gastric bypass is dumping syndrome, in which food is "dumped" from the stomach into the intestines too quickly, before it's been properly digested. About 85% of people who get a gastric bypass have some dumping. Symptoms include nausea, bloating, pain, sweating, weakness, and diarrhea. Dumping is often triggered by sugary or high-carbohydrate foods, and adjusting the diet helps. However, some experts actually see dumping syndrome as beneficial, in that it encourages people to avoid foods that could lead to weight gain.

But, the same people who won't take this pill or that pill because of the 10 page side effect list they received at the pharmacy - these same people - would like to be considered for gastric bypass surgery. Can someone explain this to me? I'm confused....

The Clinical Cases and Images blog picked up on my recent post named "The Pressure of Posting." They raise the question of whether blogging in general has kind of become passe and yesterday's news. With so many different ways to express yourself like Twitter (guilty of being on too much), Facebook, and other social networking sites, has the blog become kind of ancient?

In the world of podcasting (of which I would call myself a very minor player), there is a term called "Podfading." It is a situation in which a podcast either becomes more and more infrequent or just stops abruptly - thereby leaving the audience not quite knowing what to do. A definitely parallel can be made with blogs, video blogging, or any other new media product.

In applying all of this to me (since this is my blog, you know), I guess a hobby or a project like this - something that you think about almost every day - has a cycle of increased interest and decreased interest. In what I call "the old media world" (meaning everything not considered new media), either your career is considered rocketing to the top or fading back to the oblivion where you came from. The main stream media loves to build people up, tear them down, hype up the comeback, and tear them down again. One day you're the best thing since sliced bread and tomorrow you're a has-been hanging on to the past.

For me, I sometimes have to ask myself, what is the core of all of this? I don't blog to make money. I do not seek sponsorship for any of the new media stuff that I do. Some people do, and I don't begrudge them for that. I write, or record audio, or shoot video, just for the joy of doing it. And, I guess, there are times when I'm not as interested and other times when I am very interested. But, just like life, I have to take the good with the bad.

At least for this second, I don't see myself going anywhere. I guess I just have to keep challenging myself in this world of new media. And, I encourage all of you out there to do the same. If you have a blog, consider recording some audio and make a podcast. For those of you with that, consider shooting some video and express yourself that way. Don't know what Twitter or Facebook are? Check them out - you may actually like it.

Hmmm. Maybe I will talk about some of this stuff on the show this week. Doesn't hurt to be introspective every once in a while...

For the state of affairs around these parts, this story from our local newspaper is shocking, and yet, sad at the same time. I'll let this story speak for itself...

Warren – A man who police say kept them busy searching for his missing 2-year-old son has been charged with misuse of 911. Police reported that [the man] called 911 Saturday afternoon to report his son missing.

Six police officers searched the area for an hour, but couldn’t find the boy. When his wife returned home with her son, [the man] reportedly told police he knew his son was with her. According to the report, [the man] was under the influence of drugs and alcohol.

Sunday, April 20, 2008

This post is going to ramble. So, consider yourself warned. It doesn't take a genius to figure out that I have not been writing that much on this blog. And, I just wanted to get some thoughts out there so that they don't keep smoldering inside me.

Every time I sit down to try to write something, I feel nothing there - at least lately. The evolution of this blog is such that I started talking about patients a little bit. Then, move onward to talking about current events and topical things. And, now, I'm experimenting a little bit with a live internet radio show format and video blogging.

Especially in this latest chapter of my blogging life, I've always wanted to continue with writing on this text blog. I just don't know what I do to myself. I know I have written about this feeling here before. Of course, I want to write what I think is quality stuff. But, when I've sat down in the past 3-4 months, when I start typing, I have the thought of "If this is not the best thing you have ever written, then stop writing."

Now, it doesn't help that life has (definitely) been getting in the way of blogging over the past few months. But, when you think about it, everyone has a life outside of blogging (don't they). So, pretty much everybody has to find that balance between blog life and real life.

Since I have no scheduled guest this week on the show, this is something that I can talk about. It probably sounds too simple, but maybe the solution to writers block is - just writing. I think back to when I started this blog. I didn't care who was reading this. But, as people start to read and subscribe to this blog, something happens to the blog writer. I just have to continually remind myself that I blog for the joy of blogging and not for anything else....

Every day, older people come to see me in my office saying, "Doc, I don't know why they call this 'The Golden Years' because there is nothing golden about them." And, then, they go into their medical concerns that, hopefully, I can help them out with. But, I do have good news for older Americans because there is new research being released stating that the happiest Americans are the oldest (Associated Press).

A certain amount of distress in old age is inevitable, including aches and pains and the deaths of loved ones and friends. But older people generally have learned to be more content with what they have than younger adults, [researcher] Yang said.

This is partly because older people have learned to lower their expectations and accept their achievements, said Duke University aging expert Linda George. An older person may realize "it's fine that I was a schoolteacher and not a Nobel prize winner."

The rest of this article goes into examples of people and their point of view at the older part of life. The balance between being hard-charging to succeed and being content is something that I struggle with everyday. That stress level really bothers me sometimes. Maybe the lesson from this study is that sometimes (only sometimes) that it's ok to lower expectations and accept achievements. My life would be a a little more content and less stressful.

Friday, April 18, 2008

Thanks so much for Vijay from Scan Man's Notes for being on the show. (Video post above) He has been a long supporter of the show and I appreciate that. We talked about the training system in his country to become a physician. Did you know that radiology was not his first choice? We talk about that a little bit as well. And then, he started exhibiting some of the typical radiology arrogance that I see every day and I just had to shut him up (just kidding).

Thanks also to Mexico Med Student for flying in the co-pilots seat tonight for the show. At the beginning of the show, he talked about his current status as far as from an educational standpoint. And, then we talked about his recent post from today in which he very poignantly described his health scare. Somethings things happen the way that they do for a reason, and we reflected on that as well.

Finally, thanks so much to Dr. Val for calling into the show at the point when I most needed her. There was definitely a lull in the show while Vijay was trying to find a working connection. Tomorrow, Val is going to have an exclusive interview (probably not exclusive, but sounds good) with the former surgeon general Dr. Richard Carmona. Good luck Val!

Next week, we'll see. I have some e-mails out there. So, we'll see if I'm able to get a guest. If not, then we'll talk about anything (almost). Thanks so much for your support of the show (don't forget to rate the show here)! Have a great weekend!

Thursday, April 17, 2008

Join us tonight for The Doctor Anonymous Show . Our guest will be radiologist medblogger Vijay who is author of the blog Scan Man's Notes. It will be early morning on April 18th when Vijay calls in live from India. I'll be taking your phone calls, and who knows what we'll talk about.

You can even take part in the chat room, or what I affectionately call, "The MedBloggers Lounge." A great opportunity to interact with medbloggers you've only read about. See you for the show!

For first time Blog Talk Radio listeners:*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Wednesday, April 16, 2008

Never before in the history of The Doctor Anonymous Show has a guest done his/her own promo - until now. Vijay from Scan Man's Notes has discovered video posting for himself. In his video post above, he shares that he will be a guest on the show on Thursday, April 17th, 2008 at 9pm eastern time (6:30am 4/18 in India). It's a cute intro and it looks like he recorded it on the moon from a lunar landing. But, no criticism here. I really appreciate Vijay having the courage to post a video to talk about his own guest appearance on the show. He shares written comments on a post today entitled, "scan man on BTR." See everyone tomorrow night (or at whatever time the show is where you're at)!

The Doctor Anonymous Show welcomes Vijay from Scan Man's Notes to the show on Thursday, April 17th, 2008 at 9pm Eastern Time. He is a radiologist in India. Not only does he write clinical posts like this one, this one, and this one - on colon cancer. He also has fun posts with great pictures like the one here from where he lives.

Back in January, Vijay also started recording podcasts aptly named "Scan Man Speaks." In addition, he's started to venture into video. He made a video comment to one of my Viddler videos. Make sure you scroll down to the comments section, but you can check out his video comment here. (Also check out the music in the background of his video comment)

Finally, he initially started out his blog anonymously. But, about 5 months into blogging, he revealed his real identity here. So, we'll talk about that and a lot more on The Doctor Anonymous Show. Be there!

Monday, April 14, 2008

A quick summary of my weekend (especially Sunday) is seen above in this video post. I make reference to "Me Today" which is a group of videos on this site. Ever get a song stuck in your head? Well, that happened to me when I saw this video post by iJustine.

Then, I went to a meetup meeting for the PodCampOhio event that will take place on June 28th. (See my promo for the event here.) Close to the end of the meeting, things got a little crazy with Brandice, Joe, Matt, and Angelo. (The theme was "Show us the stickers on your laptop." Notice the two other people shooting at the same time that I was - hehe)

Finally, to finish the weekend, I went back to the office to try to clear off as much as my desk as I can to start the week fresh. Hope everyone had a great weekend!

Friday, April 11, 2008

What a great show tonight! Thanks so much to Bongi, Sid, Kerri, Vijay, and everyone who joined us live in the chat room. (Video post above). For me, it was really interesting hearing Bongi and Sid talk about how it is to be a surgeon in his country and in this country. I admit I don't know all that technical stuff. But, listening to how they approach the same procedure - fascinating.

I felt like I was at an international conference, but still in my place. Plus, with Vijay calling in live from India and describing some of the same infrastructure problems and government problems in his country and how it is the same there as it is in South Africa and/or in the United States. The more things change, the more they stay the same.

Thanks also to Kerri for calling in at the beginning of the show. Raise Your Voice is what she's trying to do to raise awareness about Type 1 Diabetes. Best of luck with that and best of luck with your wedding planning and your wedding -- next month -- Ek!

Our guest next week will be the aforementioned Vijay from Scan Man's Notes. He's a radiologist in India and has a great blog. Also, on May 1st, John Halamka from GeekDoctor.Blogspot.com. Trained as an Emergency Physician, John is on the cutting edge of information technology. And, we'll get to talk about it.

I really feel that this show is coming together as how I envisioned the thing. It's so much more than an interview show. It's a way for medbloggers to connect in a way "beyond the blog" (hehe). But, you know what I mean (I hope). Reading text posts and writing text comments are one thing, but to hear people's voices and to talk with people in real time. This is the way that the medical blogosphere is going, and I'm very excited about it. Have a great weekend, everybody! (Don't forget to rate the show here.)

In addition to all of this, I'll be taking your phone calls! Take part in the chat room, or what I affectionately call, "The MedBloggers Lounge." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you for the show!

For first time Blog Talk Radio listeners:*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Wednesday, April 09, 2008

Can you believe that this show is up to number 30? Granted that probably the first third were just trying to work out major technical difficulties. But, still, I'm surprised at myself for continuing this project this long. Anyway....

Be sure to join me for the next edition of The Doctor Anonymous Show which will be Thursday, April 10th, 2008 at 9PM eastern time on BlogTalkRadio. Our guest will be the blogger Bongi from the blog Other Things Amanzi. He is a surgeon from South Africa. He first caught my attention a few months ago when he submitted his post for my Grand Rounds last fall. Here is just a sample of a post called Cuts:

she was massive. her bmi must have been hovering around the 50 mark. then she developed severe abdominal pain, complete obstipation and vomiting. as is common, she went to her local neighbourhood sangoma. he did what sangomas do. he made cuts over the area the patient reported to be the problem (her abdomen) and smeared his muthi (in this case, apparently cow dung) into the cuts. the idea, i think, is that the medicine can get to work directly where the problem is.

Not only is he a great writer, but also someone with the most picturesque posts that I have ever seen in blogging. For a sample of this, check out a recent post called Rest and Relaxation where he shares pics from recent time off. WOW! Maybe, someday, I'll have an opportunity to visit where these pictures were taken. I'm very much looking forward to this interview.

In addition, there will be a very special co-host for this week's show. It will be the one and only Sid Schwab from Surgeonsblog. You may remember from Show #23 when Bongi called into the show to talk to Sid (around 32 minutes into the show). I thought it would be great to bring these guys back together for an extended conversation.

Also, right at the beginning of the show, I'll be talking with Kerri Morrone from Six Until Me. As I mentioned in an earlier post this week, on April 14th, 2008, Kerri is trying to raise awareness for Type I Diabetes with "Raise Your Voice." I'm very excited to talk to her about how this effort is going. And, if you didn't already know, Kerri's wedding is next month. So, I'll get to ask her about that as well.

Not only do we have all of this going on - we will also have our live chat room up and running (you MUST listen to this show live). And, we will be taking your phone calls during the show. What can be better than that? So, make sure to tune into The Doctor Anonymous Show. You'll be glad you did! (video post above)

Tuesday, April 08, 2008

One of the things I love about the blogosphere is reading people who are passionate about their point of view and wants to share it with the world. Kerri Morrone is one of these people. Her blog is Six Until Me and I have been following an education and advocacy "movement" on her blog she calls "Raise Your Voice." She has designated Monday, April 14th to 'Raise Your Voice.'

What she is looking to do is to raise awareness about Type I Diabetes Mellitus. The media is full of messages about Type II DM, and it should be with the numbers rising and younger and younger kids being diagnosed with Type II. What Kerri is trying to do is raise awareness on what has traditionally been called "juvenile onset diabetes."

I am so moved by this effort, that I have invited Kerri to be on the next edition of The Doctor Anonymous Show to briefly talk about her Raise Your Voice project and about Type I Diabetes. (This will be in addition to our already scheduled guests) So, if you haven't already, check out her blog and take part in Raise Your Voice. Good Luck, Kerri and we'll talk more on Thursday night!

Monday, April 07, 2008

I don't know what's going on, but it seems like there were a lot of people at a conference last week - like Dr. Val, Fat Doctor, and The Happy Hospitalist. Of course, I'm jealous. I guess I really should schedule some out of town time at some point soon.

Anyway, I've also taken up educating myself a little bit. But, this is a little out of necessity. My board certification in Family Medicine is up this year, and I have to take my recertification exam in a few months. In fact, I just scheduled the date for July 25th. (Maybe I should get one of those countdown clocks for my sidebar).

I don't know about anyone else, but I'm not the biggest fan of standardized tests. Even going back to the ACT, SAT, MCAT, USMLE, etc - I have this mental block and anxiety going into these exams and preparing for these exams. So, I'm in the midst of board exam preparation over the next few weeks.

Dr. Val and I talked about this on the latest edition of The Doctor Anonymous Show last week (about 10 min into the show). The problem is not learning and re-learning the stuff. It's how much can you remember and retain for the exam. There is also these test taking techniques that I have to re-learn as well. The knowledge is up there, it's just how to access it - especially when the heart is racing and the forehead is sweating. Only 108 days now - Yeesh!

Friday, April 04, 2008

Thanks so much for Paul Levy for coming on the show. We talked about the Boston Red Sox (of course) and some professional football team up there (he didn't remember the name - hehe). Then, we went into the circumstances by which he became the CEO of the hospital. He said that he had no prior hospital administrative experience (shocking to me). He, in fact, was in charge of the sewer system (Yeesh). And, there were thoughts of selling the hospital. It's now six years later and it looks like they are still around. (video post above)

To me, his philosophy is so simple, it's mind boggling. He has made hospital information as transparent as possible for anyone who wants to know it. He posts things like quality data and infection rates on his blog (good and bad). (I mistakenly mentioned financials in my video post, but I don't think I heard that in the interview - sorry). And, let me tell you, things like quality data and hospital infection rates are somethings that some hospitals don't want people to know about. This move was so trend setting that the competing hospitals up there had to do the same thing to keep pace.

I'm on my physician hospital leadership team and he gave me advice that "learning about negotiation" would be valuable as a hospital physician leader. He teaches a course about this at his hospital. I would LOVE to hear this lecture. I just have to find some time to head up to Boston. He also invited me up there in the fall for a Red Sox playoff game. Now, I didn't tell him that I live in "Cleveland Indians Nation" (as opposed to "Red Sox Nation"). So, I would probably get beat up if I wore my Cleveland Indians garb into Fenway Park. hehe

Next week, we'll be joined by South African surgeon blogger Bongi from Other Things Amanzi. He'll be calling in live where it will be about 4am where he's at. We definitely have devoted guests on The Doctor Anonymous Show. We will also be having a special guest co-host. In two weeks, we'll have Vijay from Scan Man's Notes. So, definitely stay tuned to the "number one health talk show on Blog Talk Radio" (not really, but sounds good). Have a great weekend, everybody!

Thursday, April 03, 2008

Join us tonight for The Doctor Anonymous Show . Our guest will be Paul Levy who is author of the blog Running A Hospital. Before Paul makes his appearance on the show, I'll also be talking about the April Fools Grand Rounds of this week. What did you think of it? Did you like it, did you not like it? Did your post get left out? What did you think of the multiple host format for GR? How bummed is Dr. Wes that he has to follow this next week? hehe

In addition to all of this, I'll be taking your phone calls! Take part in the chat room, or what I affectionately call, "The MedBloggers Lounge." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you for the show!

For first time Blog Talk Radio listeners:*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Wednesday, April 02, 2008

The Doctor Anonymous Show is proud to welcome Paul Levy who is President and CEO of Beth Israel Deaconess Medical Center in Boston. He is author of the blog Running A Hospital. I've always wondered what it's like being "on the other side." Of course, administrators probably feel sometimes that people like docs and nurses are on "the other side." (Video post above)

For those of you who don't work in medicine on a day-to-day basis, especially in a hospital, there are times when clinical people like docs and nurses clash with the administrative team on certain issues (did I say that nice enough). You have probably seen (or even written) posts about hospital administration. Now, don't get me wrong, this is not going to be a combative interview. But, I am looking forward to it.

One of the discussants identified four domains that he thought of as important in thinking about the ethics of a CEO blog, and about which he posed some questions:

1. Voice: Is the CEO blogger blogging as an individual or as the voice of the organization? Charlie's blog is hosted in the HPHC website and linked to HPHC marketing materials. Yours is on Blogger and not linked to the BIDMC site. But when the CEO speaks, what he or she says can't be separated from the organization.

My reply: Whenever I give a speech, or testify before a legislative or regulatory body, or give a media interview, or write an article (for this blog or a journal) people assume that I am speaking from a position of authority and responsibility for the organization. That is just something that cannot be avoided. I do my best to be aware of the institutional consequences of what I say, regardless of the forum.

So, tune in Thursday, April 3rd at 9pm Eastern Time. Also, before Paul comes on the show, I will be talking about The April Fools Grand Rounds edition this week. I was happy to be one of the co-hosts for that edition. I'll be talking about that and give you some "behind the scenes" info that you won't get anywhere else. I'm also hoping that some of the other co-hosts will call in as well. Tune in for Show 29! You'll be glad you did.

Tuesday, April 01, 2008

Welcome to Grand Rounds - sort of. For those of you who do not know, the real host this week is the one and only Grunt Doc. But, if didn't know already, he could not handle the entire GR himself. It's hard to explain. If you don't know what I'm talking about, then start with the Grunt Doc blog this week and you'll eventually end up here.

For those of you who are up to speed and are bounced here from the Medgadget blog, I encourage you to watch my video post above. Here is a presentation of a few links that I have been allowed to present: